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SELF-STUDY SERIES


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surgery schedule during the expected boil advisory period. Sur- gery schedulers will need to communicate with the surgeons and possibly move or reschedule elective surgeries. Critical instrument sets should also be allotted for unexpected emergency procedures. Depending on the anticipated length of the boil alert, it may also be necessary to arrange for instruments sets to be transported to another facility for reprocessing.


Boil advisories due to natural disasters may take days to resolve. For this reason, facilities should include water management as part of their disaster recovery planning, and their contingency planning should include water for the SPD.


When advisories are lifted Your water utility company will notify everyone when the water is safe to use without boiling. Once this happens, SPD management should contact their local water facility to determine the best steps to proceed after the advisory is lifted. The Centers for Disease Con- trol and revention D recommends  ushing all euipment water lines following each manufacturer’s instructions, draining and refi lling hot water heaters and changing all point-of-entry fi lters of euipment that uses water such as automated endoscope reprocessors. ater softeners should also be  ushed, or specifi c cycles run according to the manufacturer’s instructions. Water uality should be monitored by each facilitys water department and monitored by their risk management and infection prevention departments. uipment may need to be decontaminated before use if it was down for a longer period. Departments should always refer to each euipment manufacturer for recommendations. At this time, SPD managers should also review instrument needs with the surgical team to prioritize any instrument backlogs reuiring immediate sterilization.


• How long will the water crisis last; days, weeks or months? • Which departments will be affected? • How will these departments be affected (slowdown, shutdown or another compromise of use)?


• What should be done with soiled instruments and devices during a stoppage?


• What processes can continue with bottled or boiled water? Where can it be bought? Can the facility supply boiled water? How much is needed?


• Where can water be sourced (tankers, private wells, mobile water purifi cation systems, etc.


• What alternative high-level disinfection or sterilization processes can be used during the event (vaporized hydrogen peroxide sterilizers, tabletop steam sterilizers using bottled water, etc.)?


• Where can reprocessing be outsourced?  hat specifi c steps are needed to bring the facility back online e.g.,  ushing lines, changing fi lters, cleaning euipment, etc. There are many details to consider when developing an EWSP, and plans should include short-term solutions for limited boil alert advisories as well as steps for long-term water outages. For example, one facility experienced a weeks-long unexpected regional water shortage caused by several burst public pipes. After being forced to cancel a high number of surgical procedures and incurring considerable extra costs for back-up water sources, it was easy for leaders to justify the $500,000 expense to dig a private well and purchase water treatment euipment. This assured that the facility would have potable water during future long-term outages.


Don’t get caught off-guard


A water emergency can cause a multitude of negative operational and fi nancial conseuences for healthcare providers. If your facil- ity doesn’t yet have a thorough EWSP to address water crises, it would be wise to put one in place as soon as possible. Both the EPA and the CDC offer great information to help with this planning. The “Emergency Water Supply Planning Guide for Hospitals and Healthcare Facilities” from the CDC is the perfect place to start. If you are already prepared with a long- and short-term plan, review your plans regularly to assure that each stakeholder depart- ment knows its role and has what it needs to execute the plan. This will assure that you are prepared to minimize the negative impact to the facility, its staff and its patients and visitors. HPN


References:


1. Centers for Disease Control and Prevention. (2021, February 18). Emergency Water Supply Planning Guide for Hospitals and Healthcare Facilities. Centers for Disease Control and Prevention. https:// www.cdc.gov/healthywater/emergency/ewsp.html.


Photo courtesy STERIS


Putting heads together We have all heard it takes a village to raise a child, but it also takes a village to devise an emergency water supply plan (EWSP). Your facility should determine the appropriate departments and leaders needed to brainstorm, write a policy and implement it when needed. Identify all departments that use water and include them on the team. Members may include a facility/maintenance department manager, an infection preventionist, a perioperative manager/director, a surgical department manager/director, a ster- ile processing manager, a hemodialysis manger, a risk manager, a medical director, an operations offi cer and a food service manager. ome important uestions to consider when writing an EWSP are:


• How will the boil alert be communicated internally and exter- nally?


• Is this a partial or complete loss of water? 30 July 2021 • HEALTHCARE PURCHASING NEWS • hpnonline.com


2. Centers for Disease Control and Prevention. (2010, November 2). Hospitals, Health Care Facilities & Nursing Homes On this Page During a boil water advisory When a boil advisory is cancelled Related links General Procedures Drinking Water Cooking and Food Preparation Handwashing During a boil water advisory. Centers for Disease Control and Prevention. https://www.cdc.gov/.


3. Benson, R, (2017, May 17) Situations Where Pathogens May Present an Imminent and Substantial Endangerment to the Health of Persons under Section 1431 of the Drinking Water Act [Memorandum]. EPA. https://epa.gov


4. AAMI TIR 34: 2014 (R) 2017. Water for the reprocessing of medical devices


5. Npj, /. (2021, February 17). Boil Advisory Issued; February 17, 2021. Natchitoches Parish Journal. https://natchitochesparishjournal.com/.


6. Npj, /. (2021, February 24). NATCHITOCHES WATER SYSTEM BOIL ADVISORY STILL IN EFFECT. Natchitoches Parish Journal. https://natchitochesparishjournal.com/.


Robert Williams, MMHC, BA, CSPDT, CER, is a healthcare consultant and educator with more than 30 years of experience in leadership, management and education. His previous roles involved operations and logistics within the peri- operative and sterile processing settings. Williams is cel cedeiled  C   Ceifi ed Sterile Processing Technician and is an active member of AORN and IAHCSMM.


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